Provider Demographics
NPI:1588056501
Name:MILLER, BRANDY JO (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:JO
Other - Last Name:RINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:718 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354
Mailing Address - Country:US
Mailing Address - Phone:304-265-1288
Mailing Address - Fax:304-265-6558
Practice Address - Street 1:718 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354
Practice Address - Country:US
Practice Address - Phone:304-265-1288
Practice Address - Fax:304-265-6558
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009435421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical